Interpersonal Psychotherapy for latelife depression in general practice

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Institute for Research in Extramural MedicineVU university medical centre, Amsterdam IPT for late-life depression in general practice: feasibility and effectiveness D.J.F. van Schaik, MD, PhD

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Background Prevalence of depressive disorder among elderly primary care patients is 5-10% < 50% recognised Short-term psychotherapy often not available within general practice

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Research questions Is it feasible to introduce Interpersonal Psychotherapy (IPT) in general practice for late-life depression ? Is IPT more effective than usual GP care in the treatment of late-life depression ?

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Patients 55 years or older GDS-15 score: 5 or more DSM-IV major depressive disorder according to PRIME-MD mood module

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Exclusion criteria Ongoing treatment for depression at the time of screening Not being able to answer the questionnaires because of cognitive impairment or language barrier

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6719 Received GDS-15 4301 (64%) Completed GDS-15 834 (19%) GDS-15 ? 5 167 Excluded 30 Ineligible 46 No contact; 3 Died 88 Refused 667 (80%) Assessed for Enrollment 150 Excluded 88 Ineligible 62 Refused 143 Patients Enrolled 293 (44%) MDD Recruitment

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Participants 143 patients 12 GP (group) practices 15 therapists 9 psychiatric nurses 6 psychologists

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Interpersonal Psychotherapy(IPT) Time-limited (10 sessions) Manual based Initial phase (3 sessions): Review depressive symptoms, psycho-education Interpersonal inventory Treatment phase (5 sessions): Grief, interpersonal dispute, role-transition, or interpersonal deficit Termination phase (2 sessions): Evaluation, relapse prevention

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Feasibility from different perspectives Patients General practitioners Mental health organisations/ therapists

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Outcome measurement Effectiveness at 2 and 6 months Depressive symptoms: remission (MADRS <10), Diagnosis of depression (PRIME-MD) , Depression severity ( MADRS and GDS-15). General functioning: SF-36

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Baseline Characteristics 1

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Baseline Characteristics 2

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Drop-out 69 IPT 58 At 2-month Follow-up 58 At 6-month Follow-up 74 Usual GP Care 61 At 2-month Follow-up 62 At 6-month Follow-up 143 Patients Enrolled

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In our project it was feasible to organize IPT in general practice Facilitating: Motivation and satisfaction of participants Interfering: Finances Room in general practices

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No diagnosis of depression anymore P-value based on X2 a: assuming all missings still had diagnosis

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Remission

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Depression severity, MADRS

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Depression severity, GDS-15

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General Functioning, SF-36

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Post hoc PRIME-MD at 6 months P-value based on X2 a: assuming all missings still had diagnosis

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Post hoc GDS-15 at 6 months b: regression coefficient of the time x treatment x binary variable MADRS < 21 (yes/no) interaction, computed in random coefficient analysis.

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Conclusion It was feasible to introduce IPT in general practice. IPT was slightly more effective than CAU in patients with moderate to severe depression, not in patients with mild depression

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Discussion Remission in other studies Relatively inexperienced IPT therapists Specific interventions only for moderately or severely depressed patients? Other subgroups? What works for whom? Current concept of depression?

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References Van Schaik A, van Marwijk H, Adèr H, van Dyck R, de Haan M, Penninx B, van der Kooij K, van Hout H, Beekman A. 2006. Interpersonal psychotherapy for elderly patients in primary care. Am J Geriatr Psychiatry. Sep;14(9):777-86. Van Schaik DJ, van Marwijk HW, Beekman AT, de Haan M, van Dyck R. 2007. Interpersonal psychotherapy (IPT) for late-life depression in general practice: uptake and satisfaction by patients, therapists and physicians.BMC Fam Pract. Sep 13;8:52. Corresponding author: a.van.schaik@ggzba.nl

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Research group D.J.F. van Schaik, MD H.W.J. van Marwijk , MD PhD H.J. Ader, PhD M. de Haan, MD PhD R. van Dyck, MD PhD B.W.J.H. Penninx , PhD H.P.J. van Hout, PhD K. J. Van der Kooij, Msc A.T.F. Beekman, MD PhD

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